Mr. Johnson, a man in his late 70s, is brought to his physician by his son, who is concerned about his father's apparent problems in interpreting and dealing with what used to be normal day-to-day activities. He worries that his father might have Alzheimer's disease, but asks the physician not to tell his father if Alzheimer's disease is confirmed as the diagnosis. The son expresses strongly how devastating such a diagnosis would be for his father, an independently-minded person. After the appropriate tests, the physician believes she has a reasonably firm diagnosis of Alzheimer's disease, and discusses with a nurse and social worker the son's "impassioned plea" not to tell his father the diagnosis. The nurse notes that a strong consensus has developed over the last twenty-five years about disclosing the diagnosis of cancer to patients, and wonders if the same reasons apply to patients with Alzheimer's.
The physician responds that the arguments in favor of telling patients about cancer assume relative accuracy of diagnosis, existence of therapeutic options, and competency of patient. However, in the case of Alzheimer's, diagnoses are not certain, there are limited therapeutic options, and the patient generally suffers from an erosion of decision-making capacity and often has limited coping skills. In this case, the physician knows the family well, and knows that the son is devoted to his father's well-being and would care for him. The physician thinks patient autonomy is important, but wonders if, in this case, she should tell the son but withhold the diagnosis from this patient -- at least until a later date, when the diagnosis might be made with more certainty. (Courtesy of Dr. Michael Panicola, SSM Health Care, St. Louis, Mo.).